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BACKGROUND: Changes in food environments have the potential to affect consumption, nutritional status, and health, and understanding these changes is of utmost importance. This study, therefore, aimed to examine the fluctuation of food stores that sell fruits and vegetables over five years in the health promotion service area of Primary Health Care (PHC) in Belo Horizonte, Minas Gerais, Brazil. METHODS: This was an ecological study that used data from a food environment audit conducted in the realm of Brazilian PHC. Buffers of 1 mile (equivalent to 1600 m) were created around health promotion services to define food environments. All food stores and open-air food markets that sold fruits and vegetables (FV) within this buffer area were considered eligible. The data collection was performed during two periods: the baseline, in 2013, and after five years, in 2018. This study compares the fluctuation by the type of stores and according to the health vulnerability index (HVI). RESULTS: After 5 years, 35.2% of the stores were stable; 154 stores were closed, and 155 were opened. The stability was greater in low-vulnerability areas, and the fluctuation differed by type of store only for areas with high vulnerability. The number of supermarket decreased in high HVI territories; and local stores, showed greater stability when compared to specialized FV markets. CONCLUSIONS: The differences in store fluctuations according to the vulnerability of areas demonstrate the importance of food supply policies considering the local characteristics to reduce inequities of access to healthy foods.

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OBJECTIVE: To describe the frequency of food and beverages purchased made by Mexican households at different types of grocery retailers. DESIGN: A national cross-sectional survey. SETTING: Mexico. PARTICIPANTS: A representative sample of Mexican households (n = 70,311). MAIN OUTCOME MEASURE(S): Household food and beverages purchases. ANALYSIS: The association between amounts of food and beverages supply bought in different food retailers (as outcome) and households' sociodemographic characteristics (as covariates) was assessed using logistic and linear regression models. RESULTS: Mexican households acquired their food and beverages primarily from abarrotes stores, followed by supermarkets and mercados and tianguis. Abarrotes stores and supermarkets were sources of unprocessed and processed foods. Specialized stores, mercados, and tianguis were primary sources of unprocessed foods. Households with low socioeconomic status and those in the central or southern regions acquired more foods from abarrotes stores, mercados and tianguis, and specialized stores. Households with high socioeconomic status and living in the northern region acquired more foods from supermarkets and convenience stores. CONCLUSIONS AND IMPLICATIONS: Abarrotes stores are the primary source of food and beverages for Mexican households; however, some interventions are needed to increase their supply of unprocessed foods. Public health interventions aiming at increasing access to unprocessed foods could be done through traditional retailers.

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Objective: The purpose of this ecological study was to characterize the community food environment according to the socioeconomic condition of census tracts (CTs) in the urban area of a medium-sized city of southeastern Brazil in 2016.Method: Food establishments were identified on the streets covered by raters and information about type was collected through objective assessment. Geocoding was carried out from address observed by raters. Food establishments were categorized into establishments with predominant sale of natural or minimally processed foods, mixed establishments, and establishments with predominant sale of ultra-processed foods. The distribution of the number of establishments, by category, was evaluated according to tertiles of per capita income of the CT. The kernel estimation was used to analyze the density of establishments by category. The spatial pattern of the categories of establishments was investigated using the univariate Ripley's K-function.Results: A total of 656 establishments were evaluated. In all, 11.1% had predominant sale of natural or minimally processed foods, 44.5% were mixed, and 44.4% had predominant sale of ultra-processed foods. The average of establishments with predominant sale of natural or minimally processed foods, of ultra-processed foods, and all categories increased according to the income of the CT. There was a clustering of all categories of establishments in high-income CTs downtown. However, peripheral and low-income CTs were composed of a higher number of mixed establishments or those with predominant sale of ultra-processed foods than establishments with predominant sale of natural or minimally processed foods.Conclusions: On average, the number of all categories of establishments increased according to the per capita income of the CT and were clustered in central and higher-income regions of the city. These findings may have practical implications for the development of public policies to increase the availability of healthy foods and to reduce the sale of unhealthy foods.

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OBJECTIVE: To examine patterns of taxed and untaxed food and beverage shopping across store types after Mexico's sugary drink and non-essential food taxes, the nutritional quality of these patterns and the socio-economic characteristics associated with them. DESIGN: We performed k-means cluster analyses using households' percentage of food and beverage purchases from each store type (i.e. convenience stores, traditional shops (e.g. bodegas, tiendas, mom-and-pop shops), supermarkets, wholesalers and others). We calculated adjusted mean proportions of taxed and untaxed products (ml or g/capita per d) purchased in each pattern. We studied the associations between households' SES and shopping patterns using multinomial logistic regressions. Within shopping patterns, we obtained mean volumes and proportions of taxed and untaxed food and beverage subgroups and calculated the proportion of products purchased at each store type. SETTING: Mexico. PARTICIPANTS: Urban Mexican households (n 5493) from the Nielsen Mexico Consumer Panel Survey 2015. RESULTS: We found four beverage shopping patterns and three food shopping patterns, driven by the store type where most purchases were made. For beverages, 48 % of households were clustered in the Traditional pattern and purchased the highest proportion of taxed beverages. Low-SES households had the highest probability of clustering in the Traditional beverage shopping pattern. For foods, 35 % of households were clustered into the Supermarket pattern. High-SES households had the highest probability of clustering in the Supermarket food shopping pattern. CONCLUSIONS: The combination of store types where Mexican households purchase packaged foods and beverages varies. However, households in all shopping patterns and SES purchase taxed beverages mainly at traditional stores. Store-level strategies should be developed to intervene on traditional stores to improve the healthfulness of purchases.

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BACKGROUND: Following the 2014 sugary drinks tax implementation in Mexico, promising reduction in the volume of purchases of taxed beverages were observed overall and at different store-types. However, the tax's effects on purchasing patterns of calories and sugar remain unclear. METHODS: Using longitudinal data from Mexican households (n = 7038), we examined changes in volume, calories and total sugar of packaged beverages purchased from 2012 to 2016 overall and by store-type. We used fixed effects models to estimate means for volume, calories, and sugar of households. To address the potential selectivity from households shopping at different stores, we calculated inverse probability weights to model the purchases changes over time by store-type. RESULTS: For taxed beverages, the volume of purchases declined by - 49 ml and -30 ml in the first year and second year post tax (2014 and 2015, respectively), while purchases leveled off in the third year of the tax (2016). Calories and sugar from taxed beverage purchases decreased over time, with the majority of the declines occurring in the first two years post-tax implementation. The volume of untaxed beverage purchases increased, whereas changes in calories and total sugar of untaxed beverages were minimal. Store level purchases of taxed beverages significantly decreased in the first two years post taxation (2014 and to 2015) only in supermarkets and traditional stores. The steepest declines in purchases of taxed beverages in 2014 were observed at supermarkets (- 40 ml or - 45%). The volume of purchases of untaxed beverages increased over time in almost all store-types, while calories and sugar minimally decreased over time. CONCLUSION: Although the Mexican tax on SSBs has lowered the purchases of sugary drinks 3 years after the tax implementation, the tax should be strengthened and store-specific interventions should be implemented to further reduce SSBs purchases in the Mexican population.

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OBJECTIVE: To study the association between density of stores (food and beverage stores, stores selling only fruits and vegetables, and supermarkets) and the BMI of adults aged ≥20 years in Mexico. DESIGN: A cross-sectional study was performed. Individual data came from the 2012 National Health and Nutrition Survey, while information on stores was taken from the National Institute of Geography and Statistics' National Statistics Directory of Economic Units. A weighted least-squares model was estimated to test the association between density of stores and BMI of adults adjusting for sex, age, education, presence of hypertension, diabetes or both, household assets index and marginality index at the municipality level. SETTING: Mexico. RESULTS: An additional 1 sd in the density of fruit and vegetable stores was associated with a reduction of 0·24 (95 % CI -0·37, -0·12) kg/m2 in BMI when the densities of the other stores were at their mean values. For food and beverage store density, a difference of 1 sd was associated with an increase of 0·50 (95 % CI 0·33, 0·67) kg/m2 in BMI, while for supermarkets the corresponding association was a reduction of 0·48 (95 % CI -1·52, 0·56) kg/m2 in BMI. CONCLUSIONS: In places with a higher density of stores that offer unhealthy foods, the BMI of adults tends to be higher.

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Ecological studies are essential for understanding the environment-diet relationship. The purpose of this study was to describe environmental conditions and their relationship with fruit and vegetable (FV) consumption among Brazilian public health service users in the city of Belo Horizonte. We evaluated food stores contained within 1600 m buffer zones at 18 Health Academy Programme sites, from 2013 to 2014. Variables at the community (density, proximity and type) and the consumer (sectional location of FV; availability, quality, variety, price and advertising of FV and ultra-processed foods) nutrition environment were measured by direct observation, while aggregate data from users (income and FV consumption) were obtained by interview. Data were analysed using the Kernel intensity estimator, average nearest neighbour value and Local Moran's Index for local spatial autocorrelation. We interviewed 3414 users and analysed 336 food stores. Major geographical variations in the FV consumption were identified. Average consumption was higher (site 2A: 410.5 ± 185.7 g vs. site 4B: 311.2 ± 159.9 g) in neighbourhoods with higher income and concentration of food stores, and better index of access to healthy foods. Sites with poor FV consumption had the most stores with poor access to healthy foods (index in the first tertile, ≤ 10). In conclusion, negative characteristics of the food environment, as seen in the present study, may contribute to low FV consumption, suggesting the need for the development and consolidation of public policies aimed at creating healthy environments through built environment interventions that increase access to and consumption of healthy foods like FV.

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Introdução: as escolhas alimentares são complexas e mais bem compreendidas quandoreconhecidos os fatores que a influenciam em diferentes níveis, como o indivíduo e oambiente. Apesar do crescente interesse sobre a contribuição do ambiente para oconsumo de alimentos, os estudos ainda são pontuais, os resultados inconsistentes e asevidências restritas aos países de renda alta. Objetivo: Identificar o consumo de frutas ehortaliças (FH) e os fatores individuais e ambientais associados a este consumo entreusuários do Programa Academia da Saúde (PAS) de Belo Horizonte, Minas Gerais.Métodos: Este trabalho será apresentado em três artigos, um estudo ecológico e doistransversais. No estudo ecológico objetivou-se realizar análise exploratória dascaracterísticas do ambiente e a sua relação com o consumo de FH. Nos estudostransversais objetivou-se identificar a associação entre habilidades individuais e oambiente alimentar percebido com o consumo de FH; e investigar os fatores individuais,familiares e ambientais associados a este consumo. O estudo foi realizado com todos osusuários com 20 anos ou mais, em 18 polos do PAS amostrados por amostragem deconglomerado simples, estratificada pelas nove regiões administrativas do município. Acoleta de dados constituiu de entrevistas com os usuários dos polos do PAS (domínioindividual e familiar) e auditoria em estabelecimentos de FH contidos em buffers comraios de 1.600 metros ao redor dos polos amostrados (domínio ambiental). Os dadosindividuais investigados foram: variáveis biológicas, socioeconômicas (sexo, idade,estado civil, renda, ocupação e educação) e comportamentais (estágio de mudança,autoeficácia, equilíbrio decisão; e habilidades individuais - respostas a frases, em escalalikert, relacionadas a tempo, custo/acessibilidade e habilidade de preparar FH). Paraavaliar o ambiente alimentar, contemplou-se variáveis do ambiente alimentar familiar(segurança alimentar do domicilio)...

Introduction: food choices are complex and better understood when the influences offactors at various levels are recognized, such as the individual and environment. Despitethe growing interest in the contribution of environment to food consumption, findingsare still inconsistent and the evidence is restricted to high-income countries. Objective:To identify fruit and vegetable (FV) intake and the individual and environmental factorsassociated with this consumption among users of the Health Academy Program (HAP)of Belo Horizonte, Minas Gerais. Methods: This thesis will be presented in threearticles, one ecological study and two cross-sectional studies. In the ecological study thepurpose was to perform an exploratory analysis of the environmental conditions andtheir relationship with FV intake. The cross-sectional studies aimed to identify theassociation between individual ability and the perceived food environment with FVconsumption; and to examine the individual, family and environmental factorsassociated with this consumption. The study was conducted with all users aged 20 yearsor older from HAP centres sampled via stratified cluster sampling, stratified by the nineadministrative districts of the municipality. Data collection included face-to-faceinterviews with users of HAP centres (individual and family domain), as well as FVstore audits (environmental domain) contained within 1,600 m buffer zones at HAPsites. The individual data investigated were: biological and socioeconomic variables(sex, age, marital status, income, occupation and education) and psychosocial variables(stage of change, self-efficacy, decisional balance; and individual ability - answers toitems on likert scale regarding perceived affordability, time and preparation skills). Inorder to evaluate food environment, we measured variables from home foodenvironment (household food security),...

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OBJECTIVE: This cross-sectional study examined the association between local food environment and consumers' acquisition of ultra-processed food. METHODS: Households were randomly selected from 36 census tracts in Santos City, Brazil. Mothers, of varying economic status, who had children ages 10 or younger (n = 538) were interviewed concerning: their household food acquisition of 31 groups of food and beverages, perceptions of local food environment, food sources destinations, means of transportation used, and socioeconomic status. Food acquisition patterns were classified based on the degree of industrial food processing. Logistic regression models were fitted to assess the association between consumer behaviors and acquisition patterns. RESULTS: The large variety of fresh produce available in supermarkets was significantly related to lower odds of ultra-processed food purchases. After adjusting for sociodemographic characteristics, higher odds for minimally-processed food acquisition were associated with: frequent use of specialized markets to purchase fruits and vegetables (OR 1.89, 95% CI 1.01-2.34), the habit of walking to buy food (OR 1.58, 95% CI 1.08-2.30), and perceived availability of fresh produce in participants' neighborhood (OR 1.58, 95% CI 1.08-2.30). Acquisition of ultra-processed food was positively associated with the use of taxis as principal means of transportation to food sources (OR 2.35, 95% CI 1.08-5.13), and negatively associated with perceived availability of a variety of fruits and vegetables in the neighborhood (OR 0.57, 95% CI 0.37-0.88). CONCLUSION: The results suggest that interventions aiming to promote acquisition of less processed food in settings similar to Santos, may be most effective if they focus on increasing the number of specialized fresh food markets in local neighborhood areas, improve residents' awareness of these markets' availability, and provide appropriate transportation.

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Differential access to healthy foods has been hypothesized to contribute to health disparities, but evidence from low and middle-income countries is still scarce. This study examines whether the access of healthy foods varies across store types and neighborhoods of different socioeconomic statuses (SES) in a large Brazilian city. A cross-sectional study was conducted in 2010-2011 across 52 census tracts. Healthy food access was measured by a comprehensive in-store data collection, summarized into two indexes developed for retail food stores (HFSI) and restaurants (HMRI). Descriptive analyses and multilevel models were used to examine associations of store type and neighborhood SES with healthy food access. Fast food restaurants were more likely to be located in low SES neighborhoods whereas supermarkets and full service restaurants were more likely to be found in higher SES neighborhoods. Multilevel analyses showed that both store type and neighborhood SES were independently associated with in-store food measures. We found differences in the availability of healthy food stores and restaurants in Sao Paulo city favoring middle and high SES neighborhoods.

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Lograr una alimentación saludable, que cumpla con los requerimientos calóricos y nutricionales debe ser la meta de las políticas alimentario-nutricionales de un país. Cumplir este objetivo en comunidades desprotegidas, en transición nutricional o de escasos recursos económicos puede requerir la intervención del estado a través de programas de subsidios de alimentos para mejorar la capacidad adquisitiva de los alimentos por parte de estas poblaciones. Un mecanismo utilizado para mejorar la distribución y el acceso a los alimentos, es a través de mercados, supermercados y expendios de alimentos que proporcionen algún beneficio en términos del ahorro al momento de la adquisición de los productos. Con la finalidad de revisar sistemáticamente literatura que presenta estudios de evaluación de expendios de alimentos para programas de alimentación, se realizó una búsqueda en diferentes bases de datos. Al finalizar la búsqueda sistemática se obtuvieron 7 trabajos acorde al tema. Los hallazgos más importantes reportados en estos trabajos fueron los siguientes: la cercanía del expendio de alimentos fue sumamente importante para la adquisición de los alimentos, la oferta de alimentos es determinante (no puede adquirirse lo que no puede encontrarse en un anaquel del expendio), los expendios que ofrecían algún tipo de elemento educativo, promovieron más el conocimiento de salud de la población y finalmente el factor de desigualdad entre la oferta en los mercados de las zonas más afluentes respecto a las zonas menos favorecidas económicamente, pues la diferencia en calidad es importante con detrimento de los vecindarios más desprotegidos. Es importante entonces tomar en cuenta los expendios de alimentos para el buen funcionamiento y cumplimiento de las metas de los programas de subsidio de alimentos(AU)

Promoting a healthy intake of food for reaching the caloric and nutrient requirements of the population should be the aim of the food and nutrition policies of a country. In order to accomplish this objective, in nutrition transition communities and/or low income populations, government intervention might be required through food assistance programs for improving purchase food power and increase the availability of high quality foods at affordable prices. A way to facilitate the distribution and ameliorate the accessibility of different foods is to incorporate supermarket, markets and other types of food stores to canalize the programs objectives in particular to improve savings for the acquisition of foods. The aim of this systematic review was to search in data bases evidence based literature on the topic of food stores used in assistance food programs. 7 articles related to the topic were found. The main findings to describe how important were the markets for improving the distribution and accessibility of high quality foods were: closeness of the store to neighborhoods, the availability of foods since what cannot be found cannot be purchased, nutrition education at the store and disparities in the quality of foods between affluent and low income neighborhoods. All this reasons should taken into account when programming the actions to be taken for food assistance programs(AU)

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